A Comparative Study Of Hrct And Pathology In Cystic Lung Cancer

Background At present,lung cancer is still a common malignant tumor in the world,and has high incidence rate and mortality in clinic.At present,there are about 1 million 400 thousand people who die of lung cancer every year,and the incidence rate and mortality rate of male lung cancer are the first in all malignant tumors.The incidence rate of female lung cancer is third,and the mortality rate is second,which is only next to breast cancer.Cystic lung cancer is a special manifestation of lung cancer.In recent years,the literature of cystic lung cancer has been increasing,which has become a hot topic in the medical field.In the early stage of the international screening program for lung cancer(I-ELCAP),the incidence rate of lung cancer with cystic cavity is about 3.6%.Due to the different concepts,various names and atypical CT manifestations of this kind of lung cancer,its diagnosis and differential diagnosis are difficult to some extent,and the clinical and imaging doctors lack of understanding and experience,often miss diagnosis and misdiagnosis,which delays the early operation and treatment of patients.Objective To explore the correlation between HRCT signs and pathological types of cystic lung cancer,so as to improve the recognition of HRCT signs of this kind of lung cancer and the pathological basis of its formation,so as to improve the accuracy of clinical diagnosis.Methods From January 2011 to December 2018,45 patients with cystic lung cancer confirmed by operation and puncture pathology were selected as the study objects,All the patients were examined by CT,the clinical data of the patients were collected,the clinical data,HRCT signs and pathological types of the patients were summarized for comparative analysis,so as to deepen the understanding of HRCT signs and the formation of pathological basis of the lung cancer,To evaluate the clinical value of HRCT diagnosis.Results 1.Lung cancer with cystic cavity is a special lung cancer,which is very rare in clinic.From January 2011 to December 2018,45 cases of lung cancer with cystic cavity were collected in our hospital.There were 26 males(57.78%)and 19 females(42.22%).The proportion of males was slightly higher than that of females.The majority of the patients were middle-aged and elderly people over 45 years old.Most of them had no obvious clinical manifestations and were found suddenly during physical examination.The lesions were concentrated in the right lung and upper and middle lobes of the lungs.The main feature was isolated cystic lesions in the lungs.2.Pathological examination was performed in 8 of 45 patients by puncture biopsy,and pathological examination was performed in 37 patients by operation.Pathological examination confirmed that all patients were lung cancer with cystic cavity.40 cases(88.89%)were adenocarcinoma: 11 cases(24.44%)were well-differentiated adenocarcinoma,5 cases(11.11%)were highly-moderately differentiated adenocarcinoma,11 cases(24.44%)were moderately differentiated adenocarcinoma,7 cases(15.56%)were moderately-poorly differentiated adenocarcinoma,4 cases(8.88%)were poorly differentiated adenocarcinoma,1 case(2.22%)was moderately differentiated adenocarcinoma with mucinous adenocarcinoma,1 case(2.22%)was moderately differentiated adenocarcinoma with papillary adenocarcinoma,and 2 cases(Bronchioloalveolar carcinoma and squamous cell carcinoma were found in 3 cases(6.67%).Among them,adenocarcinoma was predominant(P ?0.05),and the degree of differentiation of the patients was good.The pathological stages were stage I in 23 cases,stage ? in 15 cases,stage ? in 3 cases,stage IV in 2 cases,and precancerous lesions in 2 cases,mainly stage I and stage ?.3.HRCT manifestations of lung cancer with cystic cavity were mainly cystic shape: 3 cases(6.67%)were round,14 cases(31.11%)were quasi round,28 cases(62.22%)were irregular.The location of cystic cavity: 33 cases(73.33%)were located on one side of the focus,12 cases(26.67%)were located in the center of the focus.The number of cysts: 27 cases(60.00%)had single cysts,18 cases(40.00%)had multiple cysts.There were solid nodules or ground glass shadow in the tissue density outside the capsule,among which 23 cases(51.11%)were mixed ground glass shadow,7 cases(15.56%)were pure ground glass shadow.33 patients(73.33%)had septum,38 patients(84.44%)had irregular lumen wall,20 patients(44.44%)had vascular passage,13 patients(28.89%)had mural nodules,39 patients(86.67%)had lobular sign,31 patients(68.89%)had burr sign,35 patients(77.78%)had pleural depression sign,36 patients(80.00%)had vascular convergence sign.4.HRCT was compared with pathology.In 40 cases of adenocarcinoma,normal alveolar tissues were replaced by tumors under light microscopy.Expansive adenoid structures were found in the tumors.The alveolar wall was slightly thickened,alveolar cavity was enlarged,and local alveolar wall was destroyed and fused.Two patients with bronchioloalveolar carcinoma showed that the tumors distributed in the alveolar cavity and grew along the alveolar wall.The part of the tumors showed honeycomb space.The alveolar cavity was destroyed and fused to form emphysema-like changes.The septum was fibrovascular tissue and the epithelial lining was tumor cells.Three cases were squamous cell carcinoma.The tumors occurred on the basis of alveoli or localized bronchiectasis.The tumors necrosed and formed thin-walled cysts.The drainage bronchus was blocked by bronchial valve.In HRCT images,the wall and septum of the cyst are tumor tissue and fibrovascular,and the gas density in the cyst is the result of the destruction and fusion of alveolar cavity structure.5.According to the characteristic imaging signs,the diagnostic accuracy of CT was 93.33%(42/45).One case was diagnosed as pulmonary cyst,one case was diagnosed as cavitary tuberculosis,and one case was diagnosed as alveolar infection.Conclusions HRCT signs of lung cancer with cystic cavity not only have the characteristics of the cystic cavity itself,but also have the typical characteristics of peripheral lung cancer,which are mainly manifested as single or multicapse,intrathecal separation,irregular inner wall of the cystic cavity,wall nodule,intrathecal blood vessels passing through,solid nodule or ground glass shadow outside the capsule,lobed sign,burr sign,pleural depression sign,blood vessel cluster sign,etc.This kind of lung cancer is mainly adenocarcinoma with good differentiation.The pathological stages are mainly stage I and stage ?.There are three types of pathological basis:(1)irregular thin-walled cystic cavity formed by fusion after tumor necrosis;(2)the tumor occurs at the alveolar septum,and the tumor tissue replaces the normal lung tissue.(3)The tumor occurred on the basis of pulmonary bullae or local bronchiectasis.The tumor necrotized and formed a thin-walled cystic cavity.The drainage bronchi formed a blockage of the bronchial valve.